Provider Demographics
NPI:1912002296
Name:KHAN, ANWAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANWAR
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 NORTH ILLINOIS STREET
Mailing Address - Street 2:STE 2
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226
Mailing Address - Country:US
Mailing Address - Phone:618-235-6867
Mailing Address - Fax:618-235-9732
Practice Address - Street 1:4010 NORTH ILLINOIS STREET
Practice Address - Street 2:STE 2
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-235-6867
Practice Address - Fax:618-235-9732
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061962208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL259401OtherHARMONY HEALTH CARE
IL13474OtherESSENCE
IL036061962Medicaid
IL0008200468OtherBLUE CROSS BLUE SHIELD
C41310Medicare UPIN
IL259401OtherHARMONY HEALTH CARE